● When attending social events, be aware of the location of bathrooms and do not wait for intermissions to void because there may be long lines. ● Use absorbent undergarments, which are designed not to feel wet or bulky. There are many different types ranging from small stick-on pads to underwear replacements (Mayo Clinic, 2014). For older adults who do not respond to these interventions, surgery, biofeedback, implants such as pessaries, medications, and other devices may be appropriate.
occurs. After this is determined, the bladder can then be emptied before leakage occurs. ● People with cognitive deficits benefit from prompted voiding. Assist with toileting every 2 or 3 hours. ● Perform Kegel exercises for urge, stress, and mixed incontinence. See Table 5 for instruction for teaching the Kegel exercises. ● Modify the environment for functional incontinence, including adequate lighting, altered clothing, or adaptive equipment. ● Provide substitution, such as bedpan, bedside commode, or urinal for functional incontinence.
Table 5: Kegel Exercises
LOCATING THE MUSCLE The success of Kegel exercises depends on using the correct technique and performing the exercises on a regular basis. The first step is to find the muscles of the pelvic floor. Commonly, a person may actually be exercising the abdominal or thigh muscles, which may worsen the problem. These are two methods for finding the pelvic floor muscles: 1. Sit on the toilet and start to urinate. Stop the flow of urine midstream. The muscles used to stop the flow are the pelvic floor muscles. Repeat this until you are skilled in knowing the feel of contracting these muscles. Avoid contracting other muscles such as the thigh or abdomen while doing this. 2. Insert a finger into the vagina and tighten the muscles around the finger as if holding back urine. Again, keep the abdominal and thigh muscles relaxed. KEGEL EXERCISE Kegel exercises may be done any time and any place, while lying down or sitting in a chair. Although it may take as long as 3 months to see a major improvement, most people notice some improvement in 4 to 6 weeks. Avoid increasing the number of repetitions and the frequency of exercises because overexercising may cause muscle fatigue and increase urine leakage. If discomfort is felt in the abdomen or back while doing these exercises, the exercises are probably being done incorrectly. Avoid holding your breath or tightening the chest while contracting the pelvic floor muscles. Relax and focus on contracting just the pelvic floor muscles. 1. Empty the bladder. 2. Tighten the pelvic floor muscles and hold for a count of 10. 3. Relax the muscle completely for a count of 10. 4. Do 10 exercises, three times per day. Note. Adapted from Mayo Clinic. (2015a). Kegel exercises: A how-to guide for women. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/ womens-health/in-depth/kegel-exercises/art-20045283. DEMENTIA OR NORMAL AGING CHANGES?
Current estimates suggest that more than 5 million Americans have some form of dementia, and that number will grow to 13.8 million for Alzheimer’s disease alone by 2050 unless a cure or prevention is found (Alzheimer’s Association, 2016). Currently, 13% of people older than age 65, and nearly one-half of those older than age 85 have dementia. More than 70% of people with dementia live at home (Alzheimer’s Association, 2016). Many older adults worry that their forgetfulness is the first sign of dementia. Older adults and others often assume that if a person has changes in memory, he or she has dementia. Many people Normal aging Knowing the basics of how the brain functions may assist healthcare professionals in understanding how memory works. The brain is made up of billions of cells called neurons that communicate with each other through small gaps called synapses. This communication is accomplished with the help of chemical substances known as neurotransmitters. Memory is dependent on healthy neurons; it is normal for neurons to die and reduce in number during a natural life course. Memory peaks between ages 20 to 30, followed by a subtle decline until age 60 when memory difficulties become more pronounced. Many people assume that memories fail with age. Some memory changes are associated with normal aging; however, the ability to learn new things does not decline. Teach your older adult patients what to expect as normal age-related memory changes: ● Slower thinking : All body systems become less efficient and slower with age, including thinking, problem-solving abilities, the speed of learning, and recall. For most people, it is normal to require more time to learn new things, solve problems, make decisions, and retrieve information. Memory
never have their memory concerns evaluated, and simply declare that they or a loved one has Alzheimer’s disease, which may not be true. There are many reasons for memory changes; some changes are normal, but others may be caused by a condition that can be treated and reversed. If the cause is Alzheimer’s disease or other dementia, it is important to receive early diagnosis and treatment. The first step to determining whether there is a problem is to have an understanding of normal aging memory changes. does not necessarily fade with age; it just takes longer for the neurons to communicate with each other. ● Difficulty in paying attention : Many memory problems are caused by a lack of attention. As a person ages, the ability to concentrate declines, distractions are more difficult to ignore, and interruptions may cause forgetfulness. Older adults also are slower to identify and comprehend incoming stimuli. Slower stimulus identification and registration are also normal. ● Different memory cues required for recall : As people age, different memory aids or cues are needed for memory recall, and perhaps more often, to retrieve information from memory. A cue can be a word, picture, smell, rhyme, or anything associated with information or events to be remembered. Retired older adults do not have the workweek, children’s school schedules, or assistants as a guide to cue them as to what day it is. Most young adults actually use more memory aids than do older adults: electronic organizers, cell phones that store phone numbers, and computers that send out automatic reminders or print
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